I
would like to thank Professor Norman Sharpe for his kind
introduction. I would also like to take this opportunity, in
front of this primary care audience, to acknowledge the
tremendous contribution Norman has made to the prevention
and management of heart disease.

This contribution has
been made both during his 10 years as Medical Director of
the Heart Foundation, and prior to that in his role at
Auckland University.

Farewell and thanks to Professor
Norman Sharpe

Norman, I would like to thank you for your
passion and commitment to improving the heart health of the
New Zealand population.

You have brought your clinical
leadership, your knowledge of the sector and your years of
expertise to bear on the issue of cardiovascular health and
you have been a tireless champion for this over the years we
have known each other.

You have made a significant
contribution over the last 30 years to expert reviews of
guidance for assessment and management of heart disease,
including being inaugural Chair of the New Zealand
Guidelines Group.

You have also provided support to the
Ministry and to me by acting as a national clinical leader
for the More heart and diabetes checks health
target.

The team at the Ministry of Health and I sincerely
thank you for your contribution and we know that we will
continue to benefit from your wisdom and leadership long
after you leave the position as Medical Director at the
Heart Foundation.

We wish you well with your new
endeavours.

Health targets

The organisation of
this symposium actively mirrors the kind of collaboration
that is needed to make further inroads into achieving
population health through primary care. The relationship
between a Primary Health Organisation, a non-government
organisation and a government agency provides a unique mix
of skills and resources. The product of this mix is the
programme provided today which, I am sure, will provide you
with inspiration to take back to your work.

We have made
great strides in primary care in relation to the particular
health target areas you will be discussing today; however,
there is still some distance between where we are now and
where we could be. It is through innovation and
collaboration that we will make further gains.

The
priorities I would like to briefly discuss today are two of
the primary care based health targets – More heart and
diabetes checks and Better help for smokers to
quit as well as the work that is underway to prevent
rheumatic fever in New Zealand.

Health Targets - More
Heart and Diabetes checks

Achievement of the More
Heart and Diabetes checks health target is well within
reach.

Last year the Government committed $15.9 million
over four years to assist DHBs to achieve the More Heart
and Diabetes checks health target.

This extra funding
is being used to increase the numbers of nurse led clinics,
improve practice management systems, establish electronic
referral pathways to specialist services, and up skill
primary care staff in the use of these tools.

At the end
of December 2013 (quarter two) 73.2 percent of the eligible
population have received a heart and diabetes check. This
quarter’s result has contributed to a 17.6 percent
improvement over the country in the last 12 months. While no
DHB has yet reached the 90 percent target, there are six
over 80 percent.

I am sure that the discussions, case
studies and innovation you share and learn about today will
contribute to further gain and improved health outcomes for
New Zealanders over the next months.

As we get closer to
achieving the target, we can renew the efforts we are making
to support New Zealanders manage their heart disease and
diabetes.

Shared treatment decisions as part of care that
is planned in partnership with patients is a feature in the
updated cardiovascular risk assessment resource you will be
talking about today.

Tobacco products kill about 5000 New
Zealanders each year. Each of these deaths is
preventable.

The Government has confronted this issue head
on. In 2011, the Government set a goal of reducing smoking
prevalence and tobacco availability to minimal levels,
thereby making New Zealand essentially a smokefree nation by
2025.

I am proud to say that we have already reduced the
prevalence of daily smoking in New Zealand to 15 percent.
However, we still have a long way to go to being
smokefree.

One of the key contributors towards our success
in tackling tobacco use is the excellent progress that we
have made with Better help for smokers to quit health
target.

Stopping smoking is the best thing a person can
do for their health. We have moved to make smoking a
medical issue that is addressed by all healthcare
professionals.

The target requires that 95 percent of
patients who smoke and are seen by a health practitioner in
public hospitals, and 90 percent of patients who smoke and
are seen by a health practitioner in primary care are
offered brief advice and support to quit smoking.

By
December 2013, the hospital component of the Better help
for smokers to quit target was 95.3 percent and national
performance for the primary care target 66.5
percent.

Although the primary care target is still below
the 90 percent goal, it represents a significant increase of
23.5 percent since the December 2012 quarter.

Many of you
will be familiar with other steps the Government is taking
to help achieved the smokefree 2025 goal. These have
included:

• Raising
the fines for retailers who sell tobacco to people under the
age of 18; and

• Introduced a Bill to progress
plain packaging of tobacco products

Rheumatic Fever

One of the Better Public Services Key Action Areas is
to reduce the incidence of rheumatic fever by two-thirds, to
1.4 cases per 100,000 people, by June 2017. This target is
ambitious.

And the international experience suggests
increased awareness indicates reported prevalence could go
up before it comes down.

Rheumatic fever is a serious but
preventable illness that can lead to lifelong health
problems for children and young people, particularly Māori
and Pacific people.

It starts with an easily treated sore
throat caused by group A streptococcal bacteria. Improving
access for the early treatment of group A streptococcal sore
throat in primary care and community settings is a key
strategy which we are using to achieve our target.

Making
sure that all strep throats are diagnosed and treated
appropriately and quickly by primary care practitioners is
also essential.

The total funding made available to DHBs
to help prevent rheumatic fever is over $45 million.
Currently there is a school throat swabbing programme that
covers over 200 schools in 10 DHBs. Over 50,000 children
are participating in the school throat-swabbing campaign
nationwide.

We are also working on increasing awareness of
rheumatic fever and reducing household transmission of group
A streptococcal bacteria by reducing household
crowding.

To improve access for the treatment of strep
throat, rapid response services to provide timely and free
sore throat assessments and treatment for high-risk young
people have been rolled out by the three Auckland metro DHBs
and Capital & Coast DHB.

The clinics are designed to reach
at-risk 4 to 19-year-olds and so are set up in easy to
access locations, such as shopping malls.

Healthy
Families NZ (HFNZ)

Tomorrow I will be making an
exciting announcement around the government’s anti-obesity
and healthy living programme Healthy Families NZ.

Healthy
Families NZ is a new initiative that aims to bring together
the right mix of leadership, encouragement, information and
resources to help people make healthier choices for
themselves and their families.

It creates local community
areas for intensive action against preventable disease.
It’s a complete reform of the way health promotion and
disease prevention will work locally.

It’s an approach
based on community-level actions; to build a health
promotion workforce that can assist communities to create
better, longer-lasting improvements.

By working with
individuals and families, early childhood centres, schools,
workplaces and sports clubs, to prevent and reduce obesity
in New Zealand, we can slow the growth of the complications
associated with excess weight, and improve the quality of
life of those living with obesity-related chronic
illness.

The Healthy Families approach is supported by a
growing body of evidence – including from Healthy Together
Victoria and Colac in Australia, and the EPODE pilots in
Europe – which suggests that concentrated, community-led
health promotion, tailored to specific community needs and
with action where people live, learn, work and play, can be
successful in addressing the underlying causes of chronic
disease.

Evidence suggests kids will weigh less, have
smaller waists and be able to run faster.

In February I
visited the Under 5 Energize programme in Waikato which is
part of the Healthy Families strategy. The Government has
allocated $1.1 million to support good nutrition guidelines
and the development of physical exercise programmes in
around 130 childhood centres in the Waikato region.

Sport
Waikato has been contracted to manage the project and has
created an Under 5 Energize team who work alongside local
early childhood centres to improve nutrition and activity
among the children.

Teachers at the kindergarten told me
parents have quickly taken to nutrition guidelines developed
for the kindergarten, and there has already been a marked
difference in the types of food coming in with the kids.
Teachers at the school are now making platters with all the
fruit coming in for all the kids to enjoy.

Many of the
Early Childhood Centres have also attended workshops run by
the Under 5 Energize team which teach children fundamental
motor skills like rolls and twists. These skills give them
the confidence to take up a broader range of sports later in
life.

Under 5 Energize was introduced as a Ministry of
Health-funded extension to the wider Project Energize
programme already running in Waikato.

Studies have shown
this programme has produced fitter, healthier kids who weigh
less, run faster, and have a better handle on healthy
nutrition than the national average.

By investing in our
kids at this young age, and fostering a sense of healthy
nutrition and exercise from the get-go, we encourage a broad
range of positive health outcomes for these children that
will continue into adulthood.

Closing
remarks

Before I leave the symposium, I would like to
acknowledge the efforts of the organising committee
including Tane Cassidy from the Health Promotion Agency, Kim
Arcus and Janna Alexander from the Heart Foundation and
Phillip Grant from the PHO Alliance. The programme appears
to be a stimulating one and I look forward to seeing and
hearing about the benefits of the collaboration and
innovation being shared
today.

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